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antipsychotics Flashcards

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1
Q

Which SGA has the highest sedation, ACH effects, and orthostasis?

A

clozapine

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2
Q

common suffix for FGA

A

“azine”

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3
Q

what is risk of iloperidone?

A

severe orthostasis

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4
Q

why is loxapine rarely used?

A

lots of DDI

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5
Q

goal level of lithium and what must patient do when they take it?

A

0.6 - 1

drink adequate water

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6
Q

three injectable SGA that are long acting

A

risperidone microspheres, paliperidone palmitate, aripiprazole

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7
Q

4 mechanisms of action of SGA

A

serotonin dopamine antagonist, D2 antagonist with rapid dissociation, D2 partial agonist, serotonin partial agonist at 5HT 1A & antagonist at 5HT 2A

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8
Q

which drug is not indicated for bipolar disorder but is often used in mood disorders?

A

oxcarbazepine

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9
Q

Which FGA is best for treating refractory schizophrenia?

A

thioridazine

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10
Q

Which lipid changes are you most likely to see in a patient on an antipsychotic?

A

triglyceride

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11
Q

Common DDI with VPA

A

carbapenem antibiotics, lamotrigine, phenytoin, warfarin

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12
Q

Which SGA do you have to closely monitor CrCl with and adjust the dose accordingly?

A

paliperidone

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13
Q

receptor involved in anticholinergic effects

A

muscarine

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14
Q

receptors that provide sedative side effects

A

histamine and alpha-1

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15
Q

generalized slowing of voluntary movement with reduction in arm movements; most noticeable signs are rigidity and tremor at rest; may see pill rolling movements of the hands, stooped posture and shuffling gait

A

pseudoparkinsonism

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16
Q

strong subjective feeling of distress or discomfort; motor restlessness, inability to sit or stand still; sometimes mistaken as agitation or increased psychosis!

A

akathisia

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17
Q

bizarre, involuntary tonic contractions of skeletal muscle; most common dystonia as buccal spasms, facial grimacing and tics; can involve back, arms, and legs

A

acute dystonic reaction

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18
Q

IF you give olazapine and benzo via IM simultaneous what can you cause in your patient?

A

respiratory depression

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19
Q

which SGA has a long half life so they can take it once daily?

A

cariprazine

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20
Q

Two SGA most likely to cause weight gain

A

clozapine and olanzapine

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21
Q

When lithium levels are > 4 or the level is >2.5 and the patient is showing cardiac/neruologic symptoms - how do you treat?

A

hemodialysis

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22
Q

how long do you have to wait to draw levels of carbamazepine?

A

7-10 days → have to wait for it to autoinduce it’s own metabolism

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23
Q

which SGA has the most EPS side effects?

A

risperidone

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24
Q

what causes NMS?

A

sudden reduction in dopamine activity

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25
Which FGA have the highest anticholinergic effects?
low potency FGA
26
why do you want to avoid giving carbamazepine with clozapine?
agranulocytosis
27
treatment for NMS
discontinue the agent and provide supportive care
28
Mid potency FGA are only used in treating
schizophrenia
29
central anticholinergic effects
delirium, psychosis, hyperthermia
30
haloperidol, fluphenazine, thiothixene, trifluoperazine, pimozide
high potency FGA
31
This SGA is used in treating schizophrenia, BPD I, and adjunct MDD
aripiprazole
32
why do you want to slowly titrate up lamotrigine?
decreases risk of Stevens Johnson Syndrome/Toxic Epidermal Necrolysis
33
90% of akithisia cases develop in
first 2.5 months of treatment
34
These two SGA have high sedative effects and moderate ACH effects?
olanzapine and quetiapine
35
dopamine 2 antagonism can lead to…
hyperprolactinemia
36
Common DDI with lithium
NSAID, ACEi/ARB, diuretics, theophylline
37
what high potency FGA is only used in treating Tourette's Syndrome?
pimozide
38
how long does the onset of pseudoparkinsonism take?
develops several days to weeks after treatment initiation
39
MOA of first generation antipsychotics
blockade of D2 receptors
40
Which FGA can shorten QTc?
perphenazine
41
side effects of clozapine
dry mouth, constipation, blurred vision, urinary retion | mad as a hatter, blind as a bat, hot as a hare, red as a beet, dry as a bone
42
why should you be cautious in using injectable haloperidol over PO?
injectable is 2x more potent
43
older high potency FGA that isn't really prescribed much?
thiothixene
44
which SGA acts like a mood light?
aripiprazole
45
which SGA can also help with treating Tourettes?
risperidone
46
what symptoms will you see in newborn whose mother received FGA treatment in the third trimester?
EPS and withdrawal symptoms
47
which high potency FGA do you give to a patient who is resistant to taking their meds and is likely to cheek their meds?
liquid fluphenzine
48
Two SGA most likely to cause diabetes
clozapine and olanzapine
49
what type of symptoms are FGA better at treating?
positive symptoms
50
FGA have higher risk of → | SGA have higher risk of →
neurological side effects | metabolic side effects
51
Which SGA do you have to take with 500 calories → must take BID so all together need 1000 calories?
ziprasidone
52
how long does it take tardive dyskinesia to develop?
months to years after treatment initiation
53
What is the difference betwee low potency and high potency FGA?
low → more sedating | high → greater risk of EPS
54
what lab value will be elevated in NMS
serum creatinine kinase → rhabdomyolysis
55
Two SGA least likely to cause weight gain
ziprasidone and aripiprazole
56
receptor that causes orthostatic hypotension
alpha-1
57
two long acting injectable FGA
fluphenzine decanoate, haloperidol decanoate
58
perphenzine and loxapine are both
mid potency FGA
59
If your patient has hepatitis or cirrhosis what high potency FGA do you want to absolutely avoid?
trifluoperazine
60
three immediate release injectable FGA
chlorpromazine, fluphenazine, haloperidol
61
Clozapine and lithium both decrease
suicide ideality
62
What method do you use when injecting FGA?
Z tracking method
63
All SGA can lengthen QTc except which two?
aripiprazole and lurasidone
64
treatment for akathisia
propranolol
65
what can hyperprolactinemia cause?
galactorrhea, sexual dysfunction, amenorrhea, gynecomastia
66
two injectable SGA with immediate release
olanzapine and ziprasidone
67
This drug is only used for the MAINTENANCE of BPD1 and epilepsy
lamotrigine
68
What effect with antipsychotics have in the elderly?
increased mortality with dementia related psychosis
69
Which SGA has the lowest risk of metabolic effects?
ziprasidone
70
patient presents with muscle rigidity, hyperthermia, altered consciousness, and autonomic dysfunction
neuroleptic malignant syndrome (NMS)
71
treatment for acute dystonic reaction
diphenhydramine or benzotropine
72
If the patient is taking high doses of haloperidol what you monitor for?
QTc prolongation
73
peripheral anticholinergic effects
dry mouth/eyes/throat, blurred vision, mydriasis, tachycardia, constipation, urinary retention
74
How does a patient need to take lurasidone?
with 350 calories
75
This SGA has rapid binding and dissociation with the D2 receptor and thus has a good side effect profile
quetiapine
76
treatments for tardive dyskinesia
valbenazine or vitamin E
77
presence of HLA B*1502 allele puts patients taking carbamazepine at 10 fold increased risk for
steven johnson syndrome
78
What lab value will become elevated in the first 3 months of an antipsychotic?
LFTs
79
VPA will cause elevated levels of ___ in the blood
ammonia
80
In order to get the antipsychotic effect from quetiapine you must?
prescribe at very high dose (600-800) or else it is just expensive benedryl
81
with which SGA does a patient need to swallow the drug as well as their saliva in order to get the full dose?
olanzapine
82
Black box warnings for clozapine?
myocarditis, reduces seizure threshold, significant orthostasis, agranulocytosis
83
How long does the onset of acute dystonic reaction take?
within 24-96 hours of drug initiation or dose change
84
what do you monitor for in a patient on thioridazine?
QTc prolongation
85
three antipsychotics least likely to cause dyslipidemia
ziprasidone, aripiprazole, lurasidone
86
chlorpromazine and thioridazine are both
low potency FGA
87
two SGA with partial agonist/antagonist actions
brexipiprazole and cariprazine
88
why do you need lifelong blood monitoring in a patient on clozapine?
risk of agranulocytosis
89
Two SGA least likely to cause diabetes
ziprasidone and aripiprazole
90
classic mood stabilizer used in manic episodes of bipolar disorder and as maintenance
lithium
91
treatment for pseudoparkinsonism
benzotropine, trihexyphenidyl, diphenhydramine, amantadine
92
stereotypical involuntary movements including sucking/smacking of lips, lateral jaw movements and fly catching dartings of the tonuge - may be irreversible
tardive dyskinesia
93
agent used in treating acute manic or mixed episodes of bipolar disorder, epilepsy, and migraine prophylaxis?
valproic acid (VPA)

Behavioral Health (4 decks)

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